<?
$authfirst_aid = set_value('authfirst_aid',$student->auth_firstaid);
$auth_emergency = set_value('auth_emergency',$student->auth_emergency_care);
$auth_emergency_nearest_hosp = set_value('auth_emergency_nearest_hosp',$student->auth_emergency_care_hospital);
$auth_oral_non_presc = set_value('auth_oral_non_presc',$student->auth_oral_non_presc);
$first_permission = set_value('first_permission',$student->first_permission);
$second_permission = set_value('second_permission',$student->second_permission);
$third_permission = set_value('third_permission',$student->third_permission);
?>
<div>
<div class="panel callout"><h6>AUTHORIZATION</h6></div>
		<form action="<?=site_url('update-student-profile/'.$student->enrollment_id);?>" method="POST">
	
	<div>
		<label style="font-weight:bold;">I give consent for my child to receive the following:</label>
	</div>
	<div class="clearfix"></div>
	<div>
		<div class="large-2 columns">
			&nbsp;
		</div>
		<div class="large-5 columns">
			<label style="font-weight:bold;">*1. Minor first aid</label>
		</div>
		<div class="large-2 columns">
			<?php if($authfirst_aid!='no'){ ?><?=form_radio('authfirst_aid', 'no');?><?php }else{ ?><?=form_radio('authfirst_aid', 'no', 'checked');?><?php } ?> No <?php if($authfirst_aid=='yes'){ ?><?=form_radio('authfirst_aid', 'yes', 'checked');?><?php }else{ ?><?=form_radio('authfirst_aid', 'yes');?><?php } ?> Yes
		</div>
		<div class="large-3 columns">
			&nbsp;
		</div>
	</div>
	<div class="clearfix"></div>
	<div>
		<div class="large-2 columns">
			&nbsp;
		</div>
		<div class="large-5 columns">
			<label style="font-weight:bold;">*2. Emergency care</label>
		</div>
		<div class="large-2 columns">
			<?php if($auth_emergency!='no'){ ?><?=form_radio('auth_emergency', 'no');?><?php }else{ ?><?=form_radio('auth_emergency', 'no', 'checked');?><?php } ?> No <?php if($auth_emergency=='yes'){ ?><?=form_radio('auth_emergency', 'yes', 'checked');?><?php }else{ ?><?=form_radio('auth_emergency', 'yes');?><?php } ?> Yes
		</div>
		<div class="large-3 columns">
			&nbsp;
		</div>
	</div>
	<div class="clearfix"></div>
	<div>
		<div class="large-2 columns">
			&nbsp;
		</div>
		<div class="large-5 columns">
			<label style="font-weight:bold;">*3. Emergency care at the nearest hospital</label>
		</div>
		<div class="large-2 columns">
			<?php if($auth_emergency_nearest_hosp!='no'){ ?><?=form_radio('auth_emergency_nearest_hosp', 'no');?><?php }else{ ?><?=form_radio('auth_emergency_nearest_hosp', 'no', 'checked');?><?php } ?> No <?php if($auth_emergency_nearest_hosp=='yes'){ ?><?=form_radio('auth_emergency_nearest_hosp', 'yes', 'checked');?><?php }else{ ?><?=form_radio('auth_emergency_nearest_hosp', 'yes');?><?php } ?> Yes
		</div>
		<div class="large-3 columns">
			&nbsp;
		</div>
	</div>
	<div class="clearfix"></div>
	<div>
		<div class="large-2 columns">
			&nbsp;
		</div>
		<div class="large-5 columns">
			<label style="font-weight:bold;">*4. Oral non-prescription medication</label>
		</div>
		<div class="large-2 columns">
			<?php if($auth_oral_non_presc!='no'){ ?><?=form_radio('auth_oral_non_presc', 'no');?><?php }else{ ?><?=form_radio('auth_oral_non_presc', 'no', 'checked');?><?php } ?> No <?php if($auth_oral_non_presc=='yes'){ ?><?=form_radio('auth_oral_non_presc', 'yes', 'checked');?><?php }else{ ?><?=form_radio('auth_oral_non_presc', 'yes');?><?php } ?> Yes
		</div>
		<div class="large-3 columns">
			&nbsp;
		</div>
	</div>
	<div class="clearfix"></div>
	<div>&nbsp;</div>
	<div>
		<span style="font-align:left;">*NOTE: If you answered "NO" to numbers 1, 2, and / or 3, you must provide the school with alternative emergency care instructions, to be kept in your child's school records / file.</span>
	</div>
	<div class="clearfix"></div>
	<div>&nbsp;</div>
	<div>
		<?=form_error('first_permission').'<br/>';?>
		<?php if($first_permission == 'yes'){ ?>
		<?=form_checkbox('first_permission', 'yes', TRUE, 'class="left"');?>
		<?php }else{ ?>
		<?=form_checkbox('first_permission', 'yes', FALSE, 'class="left"');?><?php } ?>&nbsp;&nbsp;<span style="font-style:italic;">Permission is hereby given for emergency measures to be initiated in case of accident or sudden illness with the undestanding that I will be notified as soon as possible.</span>
	</div>
	<div class="clearfix"></div>
	<div>&nbsp;</div>
	<div>
		<?=form_error('second_permission').'<br/>';?>
		<?php if($second_permission == 'yes'){ ?>
		<?=form_checkbox('second_permission', 'yes', TRUE, 'class="left"');?>
		<?php }else{ ?>
		<?=form_checkbox('second_permission', 'yes', FALSE, 'class="left"');?><?php } ?>&nbsp;&nbsp;<span style="font-style:italic;">I certify that all information given is complete and correct.</span>
	</div>
	<div class="clearfix"></div>
	<div>&nbsp;</div>
	<div>
		<?=form_error('third_permission').'<br/>';?>
		<?php if($third_permission == 'yes'){ ?>
		<?=form_checkbox('third_permission', 'yes', TRUE, 'class="left"');?>
		<?php }else{ ?>
		<?=form_checkbox('third_permission', 'yes', FALSE, 'class="left"');?><?php } ?>&nbsp;&nbsp;<span style="font-style:italic;">I acknowledge that it is my responsibilty to inform Westfields IS of any changes in my child's health, physical condition or medical needs and any changes in our address and/or contact number(s).</span>
	</div>
	<div class="clearfix"></div>
	<div>&nbsp;</div>
	
	<div class="clearfix"></div>
	<div>
		<input type="hidden" name="profile_id" value="<?=$student->profile_id;?>">
		<input type="hidden" name="enrollment_id" value="<?=$student->enrollment_id;?>">
		<input type="submit" name="update_authorization" value="Update Authorization" class="button tiny">
	</div>
	</form>
</div>